Pre School-5th Grade, Wednesday Education Registration 25-26

3-year-old (as of 9/1/2025) - 5th Grade

(If you have more than 2 children in this age group you will have to fill out this form again.)

PLEASE NOTE THAT THERE IS ONLY ONE SESSION THIS YEAR FROM 5:40-6:25 PM. *

PLEASE NOTE THAT THERE IS ONLY ONE SESSION THIS YEAR FROM 5:40-6:25 PM. 5:40-6:25PM
Child #1 Name Child #1 Name * First Last
Child #1 Gender *

Child #1 Gender Male Female
Child #1 Birthdate Child #1 Birthdate * / MM / DD YYYY
Child #1 Grade (applicable for Fall 2025) *

Child #1 Grade (applicable for Fall 2025) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Child #1 School (if applicable for Fall 2025) *
Child #2 Name Child #2 Name First Last
Child #2 Gender

Child #2 Gender Male Female
Child #2 Birthdate Child #2 Birthdate / MM / DD YYYY
Child #2 Grade (applicable for Fall 2025)

Child #2 Grade (applicable for Fall 2025) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Child #2 School (if applicable for Fall 2025)
Parent (Caregiver) Name #1 Parent (Caregiver) Name #1 * First Last
Parent (Caregiver) Cell Phone #1 Parent (Caregiver) Cell Phone #1 * - ### - ### ####
Parent (Caregiver) Email #1 *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent (Caregiver) Name #2 Parent (Caregiver) Name #2 First Last
Parent (Caregiver) Cell Phone #2 Parent (Caregiver) Cell Phone #2 - ### - ### ####
Parent (Caregiver) Email #2
Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you- please do not double-book yourself if you have a 6th grade confirmation student during the same time.: *

Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you- please do not double-book yourself if you have a 6th grade confirmation student during the same time.: September October November December January February March
Do your children have any special needs or restrictions?
Are you a member of Calvary Lutheran?

Are you a member of Calvary Lutheran? Yes No Would like to...
My child has permission to participate in any activity, games, hiking, and field trips planned for the Calvary Lutheran Education Program. I agree that the church, its personnel and volunteers and teachers will not be held responsible and hereby release them from any accidents which may occur.
THIS IS A RELEASE. I HAVE READ AND UNDERSTAND THIS RELEASE. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
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If tomorrow is Wednesday what day is today?